Korean J Orthod.  2020 May;50(3):181-187. 10.4041/kjod.2020.50.3.181.

Evaluation of cephalometric characteristics and skeletal maturation of the cervical vertebrae and hand-wrist in girls with central precocious puberty

• Kang ST
• Choi SH
• Kim KH
• Hwang CJ

• KMID: 2502627
• DOI: http://doi.org/10.4041/kjod.2020.50.3.181

Abstract

Objective
This study aimed to evaluate the differences in cephalometric characteristics and skeletal maturation in girls with central precocious puberty (CPP) via lateral and hand-wrist radiographs. We also aimed to identify the indicators that are most effective for determining skeletal maturity in these patients.
Methods
The study included 70 Korean girls (mean age, 8.5 ± 0.5 years) diagnosed with CPP at the Department of Pediatrics, and 48 normal healthy age-matched girls who visited the Department of Orthodontics and had no history of hormone treatment or growth problems. Skeletal maturation was evaluated using lateral cephalometric and hand-wrist radiographs using cervical vertebrae maturation indicators (CVMI) and skeletal maturity indicators (SMI).
Results
The mean mandibular plane angle was smaller in the CPP group than in the control group (35.8o ± 4.9o vs. 39.0o ± 6.5o), resulting in greater posterior facial height (p = 0.003). SMI was significantly greater in the CPP group (3.5 ± 1.4 vs. 2.0 ± 1.0) than in the control group (p = 0.001) and was significantly associated with CPP (r = 0.492; p = 0.001), whereas CVMI was not.
Conclusions
In comparison with the control group, the CPP group exhibited a smaller mandibular plane angle, greater posterior facial height, and greater skeletal maturation. SMI may be more suitable than CVMI for determining skeletal maturation in CPP. Hand-wrist radiography is recommended in addition to lateral cephalogram for predicting growth in girls with CPP.

Keyword

Cephalometrics; Skeletal maturation; Central precocious puberty; Hand-wrist

Figure

• 

  Figure 1 Cephalometric analysis. A, Linear measurements. N-S, Anterior cranial base length; S-Ar, posterior cranial base length; ANS-PNS, maxillary length; Ar-Go, mandibular ramus height; Go-Me, mandibular corpus length; Ar-Me, total mandibular length; N-Me, anterior facial height; S-Go, posterior facial height; AO-BO, wits appraisal. B, Angular measurements. ① SNA, The relationship of the maxilla to the cranial base; ② SNB, the relationship of the mandible to the cranial base; ③ ANB, the relationship between the maxilla and the mandible; ④ SN-GoMe, mandibular plane angle; ⑤ Ar- Go-Me, gonial angle; ⑥ SN-ArGo, ramal angle; ⑦ N-S-Ar, cranial base angle. S, Sella turcica; N, nasion; Ar, articulare; ANS, anterior nasal spine; PNS, posterior nasal spine; A, point A; B, point B; AO, the point perpendicular to the occlusal plane at point A; BO, the point perpendicular to the occlusal plane at point B; Go, constructed gonion; Me, menton.

• 

  Figure 2 A central precocious puberty (CPP) patient exhibiting differing skeletal maturation stages on cervical vertebrae maturation indicators (CVMI) and skeletal maturity indicators (SMI). The lateral cephalogram represents CVMI 1 (A, B), and the hand-wrist radiograph represents stage SMI 6 (C, D). The CPP patient’s lateral cephalogram and hand-wrist radiograph were taken at the age of 9.4 years. They were assessed as CVMI 1, SMI 6, and a Tanner–Whitehouse 3 bone age of 11.8 years.

Reference

1. Bishara SE. 2000; Facial and dental changes in adolescents and their clinical implications. Angle Orthod. 70:471–83. DOI: 10.1043/0003-3219(2000)070<0471:FADCIA>2.0.CO;2. PMID: 11138651.

2. Petrovic A, Stutzmann J, Lavergne J. Carlson DS, editor. 1990. Mechanisms of craniofacial growth and modus operandi of functional appliances: a cell-level and cybernetic approach to orthodontic decision making. Craniofacial growth theory and orthodontic treatment. Craniofacial growth series. University of Michigan, Center for Human Growth and Development;Ann Arbor: p. 13–73.

3. Malmgren O, Omblus J, Hägg U, Pancherz H. 1987; Treatment with an orthopedic appliance system in relation to treatment intensity and growth periods. A study of initial effects. Am J Orthod Dentofacial Orthop. 91:143–51. DOI: 10.1016/0889-5406(87)90472-0. PMID: 3468798.

4. Björk A, Helm S. 1967; Prediction of the age of maximum puberal growth in body height. Angle Orthod. 37:134–43. DOI: 10.1043/0003-3219(1967)037<0134:POTAOM>2.0.CO;2. PMID: 4290545.

5. Parent AS, Teilmann G, Juul A, Skakkebaek NE, Toppari J, Bourguignon JP. 2003; The timing of normal puberty and the age limits of sexual precocity: variations around the world, secular trends, and changes after migration. Endocr Rev. 24:668–93. DOI: 10.1210/er.2002-0019. PMID: 14570750.

6. Mul D, Hughes IA. 2008; The use of GnRH agonists in precocious puberty. Eur J Endocrinol. 159(Suppl 1):S3–8. DOI: 10.1530/EJE-08-0814. PMID: 19064674.

7. Lee HK, Choi SH, Fan D, Jang KM, Kim MS, Hwang CJ. 2018; Evaluation of characteristics of the craniofacial complex and dental maturity in girls with central precocious puberty. Angle Orthod. 88:582–9. DOI: 10.2319/112317-809.1. PMID: 29708396.

8. Hassel B, Farman AG. 1995; Skeletal maturation evaluation using cervical vertebrae. Am J Orthod Dentofacial Orthop. 107:58–66. DOI: 10.1016/S0889-5406(95)70157-5. PMID: 7817962.

9. Fishman LS. 1982; Radiographic evaluation of skeletal maturation. A clinically oriented method based on hand-wrist films. Angle Orthod. 52:88–112. DOI: 10.1043/0003-3219(1982)052<0088:REOSM>2.0.CO;2. PMID: 6980608.

10. Al Khal HA, Wong RW, Rabie AB. 2008; Elimination of hand-wrist radiographs for maturity assessment in children needing orthodontic therapy. Skeletal Radiol. 37:195–200. DOI: 10.1007/s00256-007-0369-4. PMID: 17912521.

11. Szemraj A, Wojtaszek-S©©omińska A, Racka-Pilszak B. 2018; Is the cervical vertebral maturation (CVM) method effective enough to replace the hand-wrist maturation (HWM) method in determining skeletal maturation?-A systematic review. Eur J Radiol. 102:125–8. DOI: 10.1016/j.ejrad.2018.03.012. PMID: 29685525.

12. Terçarolli SP. 2005; Skeletal and vertebral age - a literature review. Ortop Rev Int Func. 1:400–11.

13. Tanner JM, White-house RH, Wenger DR. 1983; Atlas of children's growth, normal variation and growth disorders. J Pediatr Orthop. 3:531. DOI: 10.1097/01241398-198309000-00026.

14. Choi SH, Fan D, Hwang MS, Lee HK, Hwang CJ. 2017; Effect of growth hormone treatment on craniofacial growth in children: idiopathic short stature versus growth hormone deficiency. J Formos Med Assoc. 116:313–21. DOI: 10.1016/j.jfma.2016.05.011. PMID: 27421175.

15. Hinkle DE, Wiersma W, Jurs SG. 2003. Applied statistics for the behavioral sciences. Houghton Mifflin College Division;Boston:

16. Health Insurance Review & Assessment Service (KR). 2019. Four-character subcategories statistics. Health Insurance Review & Assessment Service.

17. Baik JS, Choi JW, Kim SJ, Kim JH, Kim S, Kim JH. 2017; Predictive value of dental maturity for a positive gonadotropin-releasing hormone stimulation test result in girls with precocious puberty. J Korean Med Sci. 32:296–302. DOI: 10.3346/jkms.2017.32.2.296. PMID: 28049241. PMCID: PMC5219996.

18. Hoseini M, Zamaheni S, Bashizadeh Fakhar H, Akbari F, Chalipa J, Rahmati A. 2016; Comparative evaluation of the efficacy of hand-wrist and cervical vertebrae radiography for the determination of skeletal age. Iran J Radiol. 13:e21695. DOI: 10.5812/iranjradiol.21695. PMID: 27853487. PMCID: PMC5106762.

19. Lee YS, Choi SH, Kim KH, Hwang CJ. 2019; Evaluation of skeletal maturity in the cervical vertebrae and hand-wrist in relation to vertical facial types. Korean J Orthod. 49:319–25. DOI: 10.4041/kjod.2019.49.5.319. PMID: 31598488. PMCID: PMC6769260.

20. Warmeling D, Rodrigues KM, Zastrow MD, Thiesen G. 2010; Comparative study of two skeletal maturation evaluation indexes. Rev Odonto Ciênc. 25:188–93. DOI: 10.1590/S1980-65232010000200016.

21. Flores-Mir C, Nebbe B, Major PW. 2004; Use of skeletal maturation based on hand-wrist radiographic analysis as a predictor of facial growth: a systematic review. Angle Orthod. 74:118–24. DOI: 10.1043/0003-3219(2004)074<0118:UOSMBO>2.0.CO;2. PMID: 15038500.

22. Jabour ASA. 2017. Assessment of spheno-occipital synchondrosis fusion timing and an evaluation of its relationship with skeletal maturity, dental maturity and mandibular growth [PhD dissertation]. Case Western Reserve University;Cleveland: